this post was submitted on 04 Dec 2023
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what you’re missing is the fact that most of us pay for healthcare through our employer. Clearly a win, yes? no. no it is not.
For those of us “lucky” americans that did the FUKCING MATH, i pay more in healthcare + taxes when you account for the $12,000 deductibles annually and (AND!!!!) the cost of the privilege for having insurance of anywhere 600-1600 per month. Nevermind the fact the stupid private party insurance gets to decide if “I” am allowed to get a procedure. So i pay for someone else to make a decision that my doctor determines is necessary, which is declined (of course), then appealed (and denied), and now somehow i’m hooked on some fucking opiate because the pain is so great while I wait for Jim at statefarm to approve my necessary procedure. Oh, somewhere in there lets throw in a termination from my employer for showing up high on synthetically prescribed heroin (dilaudid) and now i’ve lost said insurance that i’ve paid 12000 into.
Or I could pay less in taxes by just hoping I will live longer that the conservative (and even some democrats) party dies a horrible death. All without the needed medication and coverage that is keeping me alive… am I winning yet?
So there you have it, those not paying for insurance are winning the war against… fuck, i don’t know anymore, what are we fighting? Right, right, the evils of socialized healthcare and “higher taxes”.
yes, i am ok. no the dilaudid story is true but it is not me, it was someone i knew… guy voted trump until he took care of his own mental issues permanently and fought you all the way.
For future reference:
Have your doctor write the literal phrase "medically necessary" on the order. If denied, contact the insurer and ask for the License Number of the Doctor who refuted the necessity. Keep in mind, if they're NOT a doctor it is ILLEGAL for them to make a medical decision.
If they actually get back to you with a license number, you can use that to pull the credentials of the person denying the claim. Present that information to your doctor and I'm sure they'll help write you up a nice paper to send into the medical review board of the state they're licensed in.
I've had to use this method twice with my wife's healthcare. Approvals came within an hour of requesting the license number of the person on their end making medical decisions. The key being the phrase. A doctor's order, or prescription, is a legal document. Your doc putting that phrase means "I believe in this treatment so much, I'm willing to bet my license that they need it."
YMMV as I've only had to deal with BlueCross and they hate when I call.
Great trick, thanks for this.
yeah, thanks. I know most of the tricks now with cigna and bluecross. i just hate dealing with it and it shouldn’t be necessary.
feels good to vent though.